The auricle is a complex organ, and its appearance remains important to the patients of reconstructive and aesthetic surgeons alike. Importantly, the intricacy and distinctiveness of the ear’s topography poses a particular challenge to the reconstructive surgeon treating a patient with microtia. We will learn about the auricular skin, cartilage, vasculature, innervation, embryological development, and shape. A deep understanding of this anatomy is a crucial component of the reconstructive surgeon’s arsenal, but represents only the first step in understanding microtia repair. 1. Auricular Skeleton Auricular topography is in part defined by the complex underlying cartilaginous skeleton. This skeleton is characterized by multiple named concavities and convexities, which are somewhat unique in people, whether or not ear pathology is present. A feature that infrequently varies between people is the antihelix, which runs parallel to the helical rim and divides into the superior and inferior crus superiorly. Centered around the external auditory canal, the auricle exists to funnel sound waves towards the auditory canal. The external ear also assists in locating a sound’s origins, and functions to amplify sounds with frequencies around 3 kHz, a figure within the frequency range of human speech. 2. Ear’s perichondrium Both anterior and posterior aspects of the ear’s cartilaginous framework are covered in the perichondrium. Though relatively adherent across the external ear’s entirety, the perichondrium is particularly adherent to the helical border and cartilaginous folds of the auricle. The perichondrium can be dissected away from the underlying cartilage relatively easily, as is done during auricular cartilage harvest. 3. Ear’s anterior surface skin As big a contributor to ear shape is the cutaneous covering. Anteriorly, the cartilaginous framework of the external ear is covered by extremely thin, hairless, and sensitive skin. Between these layers of cartilage and skin reside only the aforementioned perichondrium and a thin subcutaneous fat layer. It is in this subcutaneous fat layer that an array of vessels and nerves are distributed. This fact remains important when considering flap creation and harvesting techniques. The proximity between cartilage and skin in this location is closer than in any other anatomical region. 4. Ear’s posterior surface skin Posteriorly, the cartilaginous skeleton is covered by skin that is largely distinct from the auricle’s anterior surface. Specifically, this skin is thick, very smooth, and relatively mobile with respect to the underlying cartilage. These characteristics help to explain the region’s popularity as a donor site for skin grafts to the face. Deep to this skin is the superficial, or areolar fat layer, which contains vessels running perpendicular to the plane of overlying skin. This layer makes up the first of two fatty layers on the ear’s posterior aspect, the deeper of which is the lamellar layer. It is this layer that helps to explain the overlying skin’s ability to glide with respect to auricular cartilage. A fascial layer containing a complex neurovascular network lies sandwiched between the two aforementioned fat layers.

A Game-Changer in Pediatric Ear Reconstruction Microtia—congenital underdevelopment or absence of the external ear—presents one of the most intricate challenges in plastic surgery. Traditional multi-stage reconstructions using autologous rib cartilage often require waiting until the child is 8–12 years old. But now, a revolutionary one-step technique is changing the game. At Viet Duc University Hospital in Hanoi, Vietnam, surgeons are successfully reconstructing ears in children as young as 3 years old— using a single-stage surgery with endoscopic-assisted harvesting of temporoparietal fascia (TPF) and a combination of Medpor (porous polyethylene) implants and autologous rib cartilage . What’s New? This approach blends the benefits of modern materials and endoscopic techniques for safer, more effective, and aesthetically superior outcomes: Study Overview Duration : June 2018 – September 2020 Participants : 45 patients (ages 3.5–50 years) All patients had either congenital microtia or traumatic auricular loss. Preoperative hearing evaluations were performed in children, allowing coordinated treatment for auditory support when needed. Results That Speak for Themselves Aesthetic outcomes were especially impressive in the Medpor group, with clearly defined and natural-looking ear contours. Why It Matters Traditional ear reconstruction techniques like those by Brent, Nagata, and Firmin require 2–4 surgical stages. Not only does this delay treatment until later childhood, but it also places psychological and logistical burdens on families. This single-stage method eliminates multiple surgeries, reduces risk of chest deformity from rib harvesting, and supports earlier social integration for children. And unlike open techniques that often leave visible scars and cause hair loss, the endoscopic method uses just one hidden incision , maximizing both medical and cosmetic success. A Global First With 45 successful flaps harvested endoscopically using a single incision , this is the largest known clinical series worldwide employing this advanced technique. Very few centers internationally have reported similar capabilities—most prior case series ranged from just 1–10 patients. Conclusion One-step microtia reconstruction using endoscopic-assisted TPF harvesting is a milestone in pediatric reconstructive surgery . It’s reliable, reproducible with training, and offers early intervention for even the youngest patients. For parents and physicians seeking a better way forward, this technique offers hope and a path to confidence—for life.

By Ha H. Nguyen, Huyen T. T. Tran, and Hang T. T. Nguyen Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, Hanoi, Vietnam A Single Cut That Changes Lives In the evolving field of reconstructive surgery, cosmetic outcomes matter just as much as functional success—especially for procedures that impact visible areas like the ear. Traditional auricular reconstruction techniques, while effective, often leave behind long scars and areas of hair loss. But what if we told you there's now a minimally invasive alternative? Welcome to the era of single-incision, endoscopic-assisted temporoparietal fascia flap (TPFF) harvesting —a breakthrough that blends surgical precision with aesthetic sensibility. The Challenge of Auricular Reconstruction Auricular reconstruction for conditions like congenital microtia or trauma-related ear loss has long relied on two primary methods: autologous costal cartilage or porous polyethylene (PPE) frameworks. The cartilage option demands multiple stages and is delayed until children reach ages 8–12. PPE frameworks, introduced for younger children by Reinisch in the 1990s, allow earlier intervention but require meticulous soft tissue coverage to avoid complications like framework exposure. Enter the TPFF—an ideal thin and vascular flap used to cover the ear framework. Historically, harvesting this flap meant long, conspicuous scalp incisions that often led to scarring and alopecia. Not anymore. The Breakthrough Approach From 2018 to 2021, our team at Viet-Duc University Hospital treated 60 patients using a novel single-incision technique. We used an endoscope and a single discreet incision hidden along the hairline to harvest TPFFs—entirely avoiding scalp scars. Our key achievements: We successfully reconstructed ears in patients ranging from 3 to 50 years old, with many young children receiving life-changing surgery before even starting school. Why It Works Using a 30° endoscope, we navigated the complex anatomy of the scalp with precision. We carefully preserved vital arteries such as the superficial temporal artery and its branches , ensuring flap viability. In some cases, we even identified additional small arteries previously undetectable by Doppler or CT angiography. This method not only avoids unsightly scars but also reduces intraoperative blood loss, postoperative pain, and recovery time. Surgeons benefit from ergonomic ease and a magnified surgical field, and teaching this technique becomes easier via live video feed. Looking Ahead With this technique, we achieved both reconstructive goals and cosmetic excellence . And with 61 flaps—the largest series of its kind—we’re confident this approach can become the new gold standard for auricular reconstruction. Our heartfelt thanks go to Dr. John Reinisch and Dr. Ken Stewart, pioneers in microtia reconstruction, for their guidance and inspiration. For Patients and Parents If you're a parent of a child with microtia or someone dealing with an ear defect, know that solutions are becoming not just better—but also more beautiful.

Answer: Children need to be examined at an ear specialist first to determine the cause of the hearing loss. Most people with a disability only have the deformity in the outer ear and the inner ear is normal. If the cause of your hearing loss is the absence of the ear canal,  surgery  is a good choice. of shaping the outer ear, creating the outer ears and the ear canal can improve the patient’s hearing. Medpor method can be done for children over 3 years old. Get to know more